Staying Healthy And Injury-Free
June 17, 2009
By Dr. Frank Uhr
Dr. Frank Uhr
Orthopedic Surgeon
Interviewed By Melissa Moniz
What is your area of specialty?Sports medicine.
How long have you been practicing?
I began practicing with Kaiser Permanente as an orthopedic surgeon in 1990.
What is the Sports Medicine Clinic?
The Kaiser Permanente Sports Medicine Clinic opened September 2008. Our staff includes myself, Dr. Ben Chun and Dr. Jordan Chun, who are board certified in family medicine and completed sports medicine fellowships, Denise Fujiyama R.N. and Delailah Tupinio M.A., who coordinate patient care and provide patient education and support.
The clinic has features that make it unique to both Kaiser Permanente and Hawaii. First, the clinic provides open access to all patients. Patients do not need a referral from their primary-care physician or the emergency room. Instead, they may simply call the clinic directly and schedule an appointment. Second, the clinic features a sports medicine-trained orthopedic surgeon and family medicine physicians working side by side. This allows us to see and treat a wide range of sports medicine-related conditions. My training as an orthopedic surgeon enables me to focus on both surgical and non-surgical treatment of musculoskeletal injuries.
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My partners, with their backgrounds in family medicine, treat not only musculoskeletal conditions but also medically related conditions unique to sports medicine, such as concussions and exercise prescriptions. When we combine our expertise with our ability to make use of the services offered here, we can effectively manage the full spectrum of sports medicine care.
Is the clinic open to nonmembers as well?
Yes, anyone can make an appointment to see a physician in the Sports Medicine Clinic. People not enrolled with Kaiser Permanente may simply call the clinic and make an appointment. The clinic receptionist also can direct prospective patients to clinic personnel for questions regarding payment and potential reimbursement through other insurance carriers.
Is the Sports Medicine Clinic new to Kaiser or just new to Kaiser Hawaii?
The idea of having both orthopedics and family medicine working side by side in a Sports Medicine Clinic makes this clinic new to both Kaiser Permanente and Hawaii.
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Do you see more men or women at the clinic?
Although I haven’t looked at those statistics, I suspect we treat roughly equal numbers of male and female patients.
Are there any injuries that are seen more in one gender?
Although certain injuries may occur more commonly in one gender, often we see differences in the way men and women sustain their injuries. Men, particularly as they get older and busier at work, tend to cram much of their exercise and sports activities into the weekend. On Monday mornings, we often get calls from these “weekend warriors” who did too much and can’t walk or lift their arms. Women, on the other hand, seem better at obtaining their exercise on a more reasonable, regular, schedule.
What are the most common injuries that you see?
Our clinic treats a wide variety of injuries. Often, as popular community events such as the Great Aloha Run or the Honolulu Marathon approach, we see more “overuse” injuries such as “runner’s knee,” a condition that results in knee pain while running, climbing stairs and activities that require squatting. Most cases of “runner’s knee” will respond to a program involving physical therapy, stretching, the use of orthotics, a properly selected running shoe and modifications of training programs.
During high school and college football and basketball seasons we frequently see knee ligament injuries such as tears of the anterior cruciate ligament. Shoulder injuries tend to occur most commonly in sports such as volleyball, swimming, tennis and throwing, which involve overhead movements.
Looking back at orthopedics when you first started, what have been the biggest changes and advancements?
In our society, and particularly in Hawaii, people place a premium on living healthy, active lives. Furthermore, as the large number of “baby boomers” begin to feel some of the aches and pains of aging, they refuse to accept advice to “slow down” or curtail their activities. The orthopedic surgeon’s role, until recently, has not focused heavily on promoting health and preventing injury. Today, however, orthopedic surgeons must do more than just treat and operate on injuries when they occur. They also must participate in developing programs and treatments that will allow their patients to perform at their maximum and remain injury free. The Sports Medicine Clinic’s approach to maintaining health and preventing injury complements our “Thrive” campaign, which places an emphasis on helping members achieve a healthy and happy life.
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June 15-21 is Men’s Health Week. Could you offer some advice to men in regard to keeping healthy and injury free?
Men tend to resist seeking medical care and seeing doctors. I can verify this from personal experience. For these men, their best protection against chronic illness and poor health is to maintain a healthy and active lifestyle. Our clinic provides easy access and facilitates this by encouraging and enabling men to achieve and maintain that lifestyle. We also can provide other services such as nutritional counseling and exercise prescriptions to help men achieve healthy lives. Furthermore, Kaiser Permanente’s state-of-the-art system of electronic medical records enables the clinic to monitor key health parameters of its members. For men, this includes routine screening for colon cancer after the age of 50, among other procedures. Once alerted by the patient’s medical record, clinic personnel will provide the necessary information to complete these important screening tests.
Do you have any particular fitness, training or nutritional tips for men, and do they change as men age?
A healthy, well-balanced diet and a consistent program of regular exercise are key to maintaining health. I recommend an exercise program that includes both muscle strengthening and cardiovascular conditioning. I also recommend an exercise program that includes a variety of activities. As men age, this concept of “cross-training” becomes particularly important. Many men use jogging as their primary mode of exercise. As men approach middle age and beyond, weight-bearing joints such as the knee and hip may develop changes from wear and tear (osteoarthritis). Even mild osteoarthritis can make excessive running painful. For these men, we often recommend a change in the way they exercise. That does-n’t mean we tell them to stop running. Instead, we have them work on improving the strength of their legs to help protect the joints while running. We also encourage these men to alternate running with a non-impact exercise such as biking, swimming or an elliptical trainer.
What do you see as the future of orthopedics, and what big changes do you see on the horizon?
Arthritis, particularly in the knee and hip, remains a difficult problem for orthopedic surgeons to treat. We can alleviate the symptoms of arthritis with activity modifications, medication and exercise, but we don’t have a cure. When the pain from arthritis becomes unbearable, we can perform joint-replacement surgery. Although joint replacements effectively reduce the pain from arthritis, they do not allow patients to return to most sports activities that involve running or jumping.
I think the future of orthopedics will involve developing ways to resurface worn joints with new cartilage. Although still in the early stages, techniques exist today that allow transfer of cartilage cells to small areas of damage in the knee. One day, most likely using stem cell technology, orthopedic surgeons will resurface entire joints with new cartilage instead of replacing joints with metal and plastic parts. This will be a tremendous breakthrough because it will allow patients to return to unrestricted activities and require much less invasive surgery than our current joint replacements.
You mentioned arthritis being the culprit. Are there ways to prevent or delay getting arthritis?
Arthritis has a genetic component that we cannot control. Although someday with genetic engineering we may find ways to eliminate arthritis genes, until then we are stuck with what our parents gave us.
People can, however, take steps to minimize the symptoms of arthritis and control its progression. Maintaining a normal body weight through proper diet and regular, appropriate exercise can play a large role in controlling arthritis pain and progression.